한약 in Pregnancy

June-Seek Choi, M.D., PhD

Korean Motherisk ProgramDiv. of Maternal-Fetal Medicine, Dept. of OB & GYN,Cheil General Hospital & Womens Healthcare Center

DefinitionHerbal medicines relate to uterine contraction (in animal study vs human)Herbal medicines relate to spontaneous abortion (in animal study vs human)Data of pregnancy outcomes of herbal medicine exposure in Korean Motherisk Program Summary

: , , ,

4: [(), (), (), ()] : ,

5: (), (), (), (), () . .: .

: . : () () . , .

(Synergism)(Mutual enhancement): (Mutual inhibition)(Mutual detoxication):

(Incompatibility)(Mutual antagonism)

: Warfarin+, , , +corticosteroid corticosteroid : +prednisolone prednisolone

() () . 1 , .

. . , Anthraguinone (, )C15H10O5

Chinese Herbal Nephropathy (CHN): : 273 22 , 47% . (, ) ()

Park YC et al 2011

Western MedicineDrug interaction and resultsAngelicae Gigantis Radix(), Ginseng Radix, Extract of Ginkgonis GermenWarfarin, AspirinDecreased International Normalized Ratio and anticoagulant effectsGlycyrrhizae Radix ()Digoxin, Furosemide, HydrochlorothiazideLicorice and digoxin may result in increased risk of digoxin toxicity. Licorice and diuretics may result in increased risk of hypokalemia and/or reduced effectiveness of the diuretic. Ginseng Radix, Ephedrae Herba () , Zinberis Rhizoma Recens ()Glyburide, Insulin, MetforminSevere Hypoglycemia due to increase insulinGlycyrrhizae Radix ()Metoprolol, Verapamil, DiltiazemDecrease drug effect and Hypertension

Allii Bulbus ()IsoniazidDecrease serum concentration of isoniazidZinberis Rhizoma Recens ()Nifedipine, Verapamil, DiltiazemSevere HypotensionExtract of Ginkgonis GermenThiazide HypertensionExtract of Ginkgonis Germen, Ephedrae Herba ()AnticonvulsantIncrease risk of seizureGinseng RadixAzathioprine, Cyclosporine, CorticosteroidDecrease effect of immunosuppressantEphedrae Herba ()Pseudoephedrine, MAO inhibitorHypertensionEphedrae Herba ()Amiodaron, Procainamide, QuinidineProlongation of QT interval

HerbsToxicityHerbsToxicityArtemisiae Argyi Folium ()Slightly toxicToxicSlightly toxicToxicSlightly toxicMeliae Cortex ()ToxicToosendan Fructus ()Slightly toxicSulphur ()ToxicCarpesii Fructus ()Slightly toxicAgkistrodon ()ToxicEuphorbiae Pekinesis Radix () Slightly toxicPharbitidis Semen ()ToxicTribuli Fructus ()Slightly toxicCalomelas ()ToxicSlightly toxicScorpio ()ToxicPicrasmae Lignum ()Slightly toxicSophorae Subprostratae Radix ()ToxicArmeniacae Semen ()Slightly toxicPhytolaccae Radix ()ToxicSlightly toxicHirudo ()ToxicCnidii Fructus ()Slightly toxicArisaematis Rhizoma ()ToxicEupolyphaga ()Slightly toxicScolopendra ()ToxicEvodiae Fructus ()Slightly toxicToxicSlightly toxicToxicSlightly toxicRealgar ()ToxicGleditsiae Fructus ()Slightly toxicToxicTyphonii Rhizoma ()ToxicGenkwa Flos ()ToxicGinkgo Semen (())ToxicCinnabaris ()ToxicPinelliae Rhizoma ()ToxicCrotonis Semen ()Very toxicBufonis Venenum ()ToxicVery toxicDichroae Radix ()ToxicMylabris ()Very toxicAconiti Tuber Laterale ()ToxicAconiti Ciliare Tuber ()Very toxicLacca Sinica Exsiccata ()ToxicAconiti Radix ()Very toxicKansui Radix ()ToxicStrychni Semen seu nux Vomicae Semen ()Very toxic

The Pharmacopoeia Commission of PRC, 2000

Herbal nameCommon nameKorean common nameBinominal nameToxicityCrotonis SemenCroton seedCroton tiglium L. (Euphorbiaceae) Very toxicMylabrisMylabrisMylabris cichorii Fabricius (Meloidae)Mylabris phalerata Pall. (Meloidae)Mylabris sidae Fabricius (Meloidae)Very toxic

Aconiti Ciliare TuberWild aconite (tuber)Aconitum ciliare DC. (Ranunculaceae) Very toxicAconiti Kusnezoffii RadixWild aconite (tuber)Aconitum kusnezoffii Reichb. (Ranunculaceae)Very toxic

Aconiti Proliferum RadixWild aconite (tuber)Aconitum proliferum Nakai (Ranunculaceae)Very toxic

Aconiti RadixWild aconite (tuber)Aconitum triphyllum Nakai (Ranunculaceae)Very toxic

Aconiti RadixAconite main tuberAconitum carmichaeli Debx. (Ranunculaceae)Aconitum chinense Paxton (Ranunculaceae)Very toxicStrychni Semen seu nux Vomicae SemenNuxvomicaStrychnos nux-vomica L. (Loganiaceae) Very toxic

Constituents4-alpha-Deoxy-5-hydroxy-20-acetoxy-12-O-(2-methyl-amino-benzoyl)phorbol 4-alpha-Deoxy-5-hydroxy-12-O-(N-deca-2,4,6-trienoyl)phorbol 4-alpha-Deoxy-12-O-(2-methylbutyryl)-phorbol-13-acetate 4-alpha-Deoxy-12-O-tiglyl-phorbol-13-acetate 4-alpha-Deoxy-12-O-tiglylphorbol-13-isobutyrate 4-alpha-Deoxy-phorbol-13-acetate 4-alpha-Phorbol Angelic acid Cocacinogen A1 Cocacinogen A2 Cocacinogen A3 Cocacinogen A4 Cocacinogen B1 Cocacinogen B2 Cocacinogen B3 Cocacinogen B4 Cocacinogen B6 Cocacinogen B7 Crotin I Crotin tiglium lectin Crotonoside 4-Deoxyphorbol tiglate acetate 4-Deoxy-5,13,20-triacetoxy-12-O-(n-deca-2,4,6-trienoyl)phorol 4,20-Dideoxy-5-hydroxy-12-O-(n-deca-2,4,6-trienoyl)-phorbol-13-acetate 12-O-Acetylphorbol-13-acetate 12-O-(alpha-Methyl-butyryl)-phorbol-13-decanoate Octyl acetate 12-O-[2-Methyl-amino-benzoyl]-4-alpha-deoxy-5-Hydroxy-phorbol 12-O-[2-Methyl-amino-benzoyl]-4-alpha-deoxy-phorbol-5,13,20-triacetate 12-O-[2-Methyl-amino-benzoyl]-4-deoxy-5-hydroxy-phorbol-13-acetate 12-O-[2-Methyl-amino-benzoyl]-4,20-dideoxy-5-hydroxy-phorbol 12-O-[2-Methyl-amino-benzoyl]-4,20-dideoxy-5-hydroxy-phorbol-13-acetate 12-O-[2-Methyl-amino-benzoyl]-4,20-dideoxy-phorbol-5,13-diacetate 12-O-(2-Methyl-butyryl)-phorbol-13-acetate 12-O-(2-Methylbutyryl)-phorbol-13-isobutyrate 12-O-[n-Deca-2,4,6-trienoyl]-4-deoxy-5-hydroxy-phorbol-13-acetate 12-O-[n-Tetradecanoyl]-4,20-dideoxy-5-hydroxy-phorbol-13-acetate 12-O-Tigloylphorbol-13-(2-methyl)-butyrate 12-O-Tiglylphorbol 13-isobutyrate 12-O-Tiglylphorbol-13-acetate Phorbol Phorbol 13-butyrate 12-tiglate Phorbol 13-caprylate 12-acetate Phorbol 13-caprylate 12-tiglate Phorbol 13-linoleate 12-acetate Phorbol 13-myristate 12-acetate Phorbol-13-acetate Phorbol-12-tiglate www.tradimed.co.kr

Aconiti Ciliare TuberAconiti Kusnezoffii RadixAconitinePhytochemical group: AlkaloidMolecular weight: 645.75Bioactivity: bind to neurotoxin binding site 2 of -subunit of Na+ channel activation of Na+ channel , increase intracellular Ca2+ arrhythmia Hanbang Yangnihak 2010Toxicity: Very toxic if swallowed or by skin absorption. Human systemic effects by ingestion. LD50 (mus, orl) 1 mg/kg, LD50 (mus, ivn) 0.175 mg/kg, exp. lethal doses by subcutaneous route reported. LD50 in mice (mg/kg): 0.166 i.v.; 0.328 i.p.; approx 1 orally (Dybing); also reported as LD50 in mice (mg/kg): 1.8 orally, 0.270 s.c.; 0.380 i.p.; 0.12 i.v. (Sato). www.tradimed.co.kr

Hanyak yangnihak 2001

Herbal nameCommon nameKorean nameBinominal nameLycii Radicis CortexLycium root barkLycium chinense Mill. (Solanaceae)Lycium barbarum L. (Solanaceae)Dianthi HerbaDianthusDianthus chinensis L. (Caryophyllaceae)Dianthus superbus L. (Caryophyllaceae)Aurantii Fructus ImmaturusUnripe bitter orangeCitrus aurantium var. daidai Makino (Rutaceae)Crataegi FructusCrataegus fruitCrataegus pinnatifida Bunge (Rosaceae)Typhae PollenTypha pollenTypha angustifolia L. (Typhaceae)Cnidii RhizomaCnidium (root)Cnidium officinale Makino (Umbelliferae)Chuanxiong RhizomaCnidium rhizomeLigusticum chuanxiong Hort. (Umbelliferae)Ligustici RhizomaLigusticum rhizomeLigusticum wallichii var. officinale Yook (Umbelliferae)Corydalis TuberCorydalis (tuber)Corydalis ternata Nakai (Papaveraceae)Corydalis ambigua Chamisso et Schlechtendal (Papaveraceae)Corydalis decumbens Pers. (Papaveraceae)Corydalis nakaii Ishidoya (Papaveraceae)Leonuri HerbaChinese motherwortMotherwortLeonurus sibiricus L. (Labiatae)Leonurus heterophyllus Sweet (Labiatae)Carthami FlosCarthamus flower (safflower)Carthamus tinctorius L. (Compositae) Angelicae Gigantis RadixDang gui rootAngelica gigas Nakai (Umbelliferae)Angelicae Sinensis RadixDang gui rootAngelica sinensis (Oliv.) Diels (Umbelliferae)Angelicae Acutilobae RadixDang gui rootAngelica acutiloba Kitagawa (Umbelliferae)Cassiae SemenFeotid cassia (seed)Cassia tora L. (Leguminosae) Cassia obtusifolia L. (Leguminosae)

Constituents of Cnidii RhizomaAdenosine Apiol Butylidenephthalide Butylphthalide Chlorogenic acid Cnidilide Coniferyl ferulate Ferulic acid Ligustilide Ligustilidiol Neocnidilide Pregnenolone Senkyunolide Senkyunolide B Senkyunolide C Senkyunolide D Senkyunolide F Senkyunolide G Senkyunolide H Senkyunolide I Senkyunolide J Umbelliferose Vanillin Vitamin C www.tradimed.co.kr

Korean Motherisk Program, unpublished

Number%Spontaneous abortion2/802.5IUFD4/785.1Preterm birth8/7810.3LBW3/783.8Malformation2*/782.6* Mega-cysterna magna(11mm) Left ventriculomegaly of cerebrum (11mm)

Median (Min.-Max)Last exposure weeks4.6 (0.6-12.4)Duration of exposure (days)2.0 (1.0-59.0)Dosage (mg/day) (42/80)1,250 (9.3-9,000)

Chart1

1

1

3

2

4

2

46

14

7

Indications

Indications

Sheet1

Indications

Dermatological preparations1

Gynecological antiinfectives and antiseptics1

Sex hormones & modulators the genital system3

Antiinflammatory & antirheumatic products2

Analgesics4

Antiobesity preparations (excluding diet products)2

Cough and cold preparations46

Drugs for functional gastrointestinal disorders14

others7

OBJECTIVE: To prospectively evaluate the fetal andneonatal outcome in women inadvertently exposed to Cnidii Rhizoma during pregnancy. METHODS: In a prospective cohort study design, 111 singleton pregnant women who were taking Cnidii Rhizoma for various reasons, and 219 age-matched singleton pregnant women not exposed to any potential teratogenic agent, were followed up until delivery.

Cases(n=111)Controls(n=219)95% CI for the differenceP-valueAge (years)31.9 4.031.6 3.7-1.3, 0.50.350Gravidity (n)2.2 1.32.2 1.3-0.3, 0.30.797Parity (n)1.0 (0, 2.0)1.0 (0, 3.0)-0.1, 0.20.867Body mass index (kg/m2)20.8 2.920.6 3.8-1.0, 0.60.662Exposure to X-raysa) n (%)11 (9.9)36 (16.4)OR= 0.6 (0.3, 1.1)0.109b) total dose (mSv) 0.01 (0.0006, 36.0)0.005 (0.0006, 38.8)-7.6, 6.00.810c) gestational age at exposure (weeks)4.0 2.63.7 2.4-2.0, 1.40.703Exposure to alcohol (%)a) n (%)51 (45.9)87 (39.7)OR= 1.3 (0.8, 2.0)0.279b) total dose (oz) 1.6 1.31.4 1.3-0.8, 0.20.215c) gestational age at exposure (weeks)4.0 2.84.7 3.1-0.3, 1.80.177Smoking (%)a) n (%)9 (8.1)23 (10.5)OR= 0.8 (0.3, 1.7)0.487b) cigarettes/day 5.9 6.47.1 5.4-3.5, 6.00.594c) gestational age at exposure (weeks)3.0 2.14.5 2.9-0.8, 3.80.203Comorbidities [n (%)]0.737a) type 2 diabetes mellitus-1 (0.5)-b) hypertension1 (0.9)--c) thyroid disease-1 (0.5)-Education level [n (%)]0.359a) post-secondary education49 (44.1)93 (42.5)b) high school 6 (5.4)22 (10.0)c) not answered56 (50.5)104 (47.5)

INDICATIONSan (%)Analgesics 4 (3.6)Anti-inflammatory enzymes2 (1.8)Anti-obesity preparations4 (3.6)Cough and cold preparations60 (54.1)Dermatological preparations2 (1.8)Functional gastrointestinal disorders19 (17.1)Gynecological antiinfectives and antiseptics1 (0.9)Psycholeptics3 (2.7)Others16 (14.4)Median (range) Dose (mg/day)b1250.0 (1.0 12000.0)Cumulative dose (mg/kg)b25.5 (0.03 5117.7)Duration of exposure (days)c2.0 (1.0 -366.0)Gestational age at last dosec4.4 weeks (1 day - 12.4 weeks)

Cases (n= 108)Controls (n= 204)95% CI for the differenceP valueGestational age at birth (weeks)38.9 2.439.4 1.60.1, 0.90.044Birth weight (g)3,227.6 506.23,308.8 452.1-29.2, 191.60.149Birth length (cm)49.3 2.049.7 1.8-0.0, 0.90.052Head circumference at birth (cm)34.4 1.334.7 1.20.1, 0.70.013Apgar score, 1 min8.2 1.48.3 0.8-0.2, 0.30.504Apgar score, 5 min8.9 1.49.1 0.7-0.1,0.40.186IUFD (%)3 (2.8)1 (0.5)OR= 5.8 (0.6, 56.4)0.121Major malformationsa (%)3 (2.8)12 (5.9)OR= 0.5 (0.1, 1.7)0.174Minor malformations (%)6 (5.6)19 (9.3)OR=0.6 (0.2, 1.5)0.245NICU admission (%)14 (13.1)23(11.3)OR= 1.2 (0.6, 2.4)0.651Duration of NICU admission (days)11.3 4.19.8 5.0-4.7, 1.80.369Breathing difficulty at birth (%)27 (25.2)45 (22.2)OR= 1.2 (0.7, 2.0)0.543Neonatal jaundice (%)10 (9.3)19 (9.4)OR= 1.0 (0.5, 2.2)0.997

Our study suggests that Cnidii Rhizoma is not a major human teratogen. Whether the reduced gestational age at birth, birth length and head circumference are of any clinical relevance in the neurological development of in-utero exposed babies, remains to be elucidated in further studies.


Number%Spontaneous abortion1/254.0IUFD-0Preterm birth1/244.2LBW-0Malformation1*/244.0* Post axial polydactyly of left foot

Median (Min.-Max)Last exposure weeks5.4 (0.4-13.0)Duration of exposure (days)3.0 (1.0-38.0)Dosage (mg/day) (16/25)180 (75.0-7,200)

Chart1

3

1

1

1

18

1

Indication

Sheet1

Indication


Analgesics1




others1

.

Constituents of Angelicae Gigantis Radix Aegelinol alpha-Pinene(+,-) Choline Coumarin Decursidin Decursin Decursinol Decursinol angelate Decusinol angelate Gigasol Imperatorin Isoimperatorin Marmesin Nodakenetin Nodakenin p-Cymene Prenyletin Umbelliferone www.tradimed.co.kr


Median (Min.-Max)Last exposure weeks4.6 (0.6-12.6)Duration of exposure (days)3.0 (1.0-59.0)Dosage (mg/day) (34/74)1,250 (13.5-9,000)

Number%Spontaneous abortion3/744.1IUFD2/712.8Preterm birth6/718.5LBW1/711.4Malformation1*/711.4* Mega-cysterna magna(11mm)

Chart1

1

1

2

4

2

6

5

1

32

10

10

Indication

Sheet1

Indication

dermatological preparations1

Anti-acne preparations1




Analgesics6


psycholeptics1


others10


Hanyak yangnihak 2001

Herbal nameCommon nameKorean nameBinominal nameMenthae HerbaMintMentha arvensis var. piperascens Malinv. (Labiatae)Mentha haplocalyx Briq. (Labiatae)Trichosanthis RadixTrichosanthes rootTrichosanthes kirilowii Maxim. (Cucurbitaceae)Moutan Radicis CortexMoutan root barkPaeonia suffruticosa Andr. (Paeoniaceae)Lonicerae FlosLonicera flowersLonicera japonica Thunb. (Caprifoliaceae)Lonicera confusa DC. (Caprifoliaceae)Kansui RadixKansui rootEuphorbia kansui Liou ex Wang (Euphorbiaceae)Clematidis RadixClematis (root)Clematis mandshurica Rupr. (Ranunculaceae)Clematis chinensis Osbeck (Ranunculaceae)Clematis hexapetala Pall. (Ranunculaceae)SulphurSulphurSulphurCurcumae Longae TuberCommon turmeric Curcuma longa L. (Zingiberaceae) Curcumae RhizomaZedoaryCurcuma phaeocaulis Val. (Zingiberaceae)Curcuma kwangsiensis S. G. Lee et C. F. Liang (Zingiberaceae)Achyranthis RadixAchyranthes rootAchyranthes japonica Nakai (Amaranthaceae)Achyranthes bidentata Bl. (Amaranthaceae)Achyranthes fauriei Leville et Vaniot (Amaranthaceae)Pinelliae RhizomaPinellia rhizomePinellia ternata (Thunb.) Breit (Araceae)Aristolochiae FructusAristolochia fruitAristolochia contorta Bunge (Aristolochiaceae)Aristolochia debilis Sieb.et Zucc. (Aristolochiaceae)Albizziae CortexSilk tree barkAlbizia julibrissin Durazz. (Leguminosae)MoschusMuskMoschus moschiferus L. (Moschidae)Moschus berezovskii Flerov (Moschidae)Moschus sifanicus Przewalski (Moschidae)


Median (Min.-Max)Last exposure weeks4.3 (0.4-12.6)Duration of exposure (days)3.0 (1.0-46.0)Dosage (mg/day) (25/48)852 (20.0-2,256)

Number%Spontaneous abortion1/482.1IUFD-0Preterm birth3/476.4LBW2/474.3Malformation-0

Chart1

1

1

1

2

39

4

Indication

Sheet1

Indication

Anti-inflammatory enzymes1


Analgesics1




.


Median (Min.-Max)Last exposure weeks4.5 (0.4-12.4)Duration of exposure (days)2.0 (1.0-53.0)Dosage (mg/day) (18/43)625.5 (2.67-3,340)

Number%Spontaneous abortion-0IUFD2/434.7Preterm birth4/439.3LBW3/437.1Malformation1*/432.3* Mega cysterna magna (11mm)

Chart1

1

1

1

1

1

1

21

2

1

13

Indication

Drugs for functional gastrointestinal disorders

30%

Sheet1

Indication

Dermatological preparations1

Antiemetics & antinauseants1




Analgesics1


others2

Drugs for acid related disorders1


Unpublished data


Age (years)32.0 3.6Gravidity (n)2.2 1.3Parity (n)1.0 (0, 3.0)Body mass index (kg/m2)20.8 3.2Exposure to X-raysa) n (%)54 (16.8)b) total dose (mSv) 0.005 (0.0005, 28.8)c) gestational age at exposure (weeks)4.8 3.2Exposure to alcohol (%)a) n (%)128 (39.9)b) total dose (oz) 1.6 1.4c) gestational age at exposure (weeks)4.6 2.3Smoking (%)a) n (%)23 (7.2)b) cigarettes/day 5.4 4.4c) gestational age at exposure (weeks)6.3 4.6

Comorbidities [n (%)]a) type 2 diabetes mellitus1 (0.3)b) hypertension2 (0.6)c) thyroid disease2 (0.6)d) cancer1 (0.3)e) renal disease1 (0.3)Education level [n (%)]a) post-secondary education130 (40.5)b) high school 20 (6.2)c) not answered171(53.3)Occupationa) professional, technical and related occupations 54 (16.8)b) executive, administrative, managerial and sales occupations136 (42.4)c) construction workers124 (38.6)d) unemployed7 (2.2)

aAccording to the pharmacological/therapeutic subgroups of the ATC classification system (World Health Organization Collaborating Centre for Drug Statistics Methodology 2011)Korean Motherisk Program, unpublished

INDICATIONS an (%)Analgesics 8 (2.5)Anti-acne preparations2 (0.6)Anti-emetics & anti-nauseants1 (0.3)Anti-inflammatory enzymes8 (2.5)Anti-inflammatory & anti-rheumatic products7 (2.2)Anti-obesity preparations21 (6.5)Anti-thrombotic agents2 (0.6)Cough and cold preparations129 (40.2)Dermatological preparations3 (0.9)Drugs for acid related disorder1 (0.3)Functional gastrointestinal disorders93 (29.0)Gynecological anti infectives and antiseptics11 (3.4)Psycholeptics2 (0.6)Sex hormones & modulators the genital system7 (2.2)Others26 (8.1)

197 kinds of herbal medicinesKorean Motherisk Program, unpublished

Median (range)Numbers of herbal medicine including one prescription7.0 (1.0 - 40.0)Duration of exposure (days)3.0 (1.0 365.0)Gestational age at last dose (weeks)4.7 (0.1 - 25.0)


Chart1

188

75

91

46

81

71

103

65

71

57

57

48

43

45

43

45

41

40

33

n

1

Sheet1

1

Glycyrrhizae Radix (Gam cho)188

Angelicae Gigantis Radix (Dang gui)75

Platycodi Radix (Kil kyoung)91

Astrgali Radix (Hwang ki)46

Cnidii Rhizoma (Chun gung)81

Paeoniae Radix (Jag yag)71

Zingiberis Rhizoma Siccus (Geun gang)103

Cinnamomi Corte (Yug gae)65

Zizyphi Fructus (Dae chu)71

Cinnamomi Ramulus (Gae ji)57

Ginseng Radix (in sam)57

Menthae Herba (Bak ha)48

Pinelliae Rhizoma (Ban ha)43

Antelopis Cornu (Young yang gak)45

Rehmanniae Radix (Ji hwang)43

Zinberis Rhizoma Recens (Saeng gang)45

Cyperi Rhizoma (Hyang bu ja)41

Schizonepetae Herba (Hyung gae)40

Coptidis Rhizoma (Hwang ryun)33


Cases (n= 307)Gestational age at birth (weeks)38.9 2.4Birth weight (g)3,294.2 511.8Birth length (cm)49.7 2.2Head circumference at birth (cm)34.6 1.4Apgar score, 1 min8.3 0.9Apgar score, 5 min9.0 0.7IUFD (%)6 (2.0)Malformationsa (%)7 (2.3)NICU admission (%)12 (3.9)Duration of NICU admission (days)12.5 9.2Neonatal jaundice (%)10 (3.3)a A baby born with megacisterna magna, second one with dysplastic change of left kidney, left ectopic ureteral insertion, third one with small pulmonary artery, fourth one with polydactyly of 5th toe of left foot and cleft palate and patent ductus arteriosus, fifth one with small echogenic foci of anterior papillary muclse of left ventricle heart, sixth one with borderline left ventriculomegaly of cerebrum, and seventh one with patent ductus arteriosus

*: , : , : :

Croton tiglium L. (Euphorbiaceae) . , , . , . 0.1-0.3gm , . .()(Croton seed without husk) : () . . () () () . 1. Soak the croton seeds in thin rice gruel or washing water of noodle and scoop up. 2. Dry it in the sun. Or heat it until its husk bursts open and peel off by hands., ()(Croton seed plaster): () () .( 1 : , 7())1. Pound the croton seeds and add sesame oil or brewed liquor. 2. Boil it down to be plaster to use.(one Crotonis Semen : brewed liquor, sesame oil 5.6 l) , ()(Croton seed frost-like powder): () . () . 2 . 6~7 . () (), (), (), () . 1. Pound the croton seeds and wrap in many folds of paper to absorbs oil. 2. Heat them to dry and remove the oil. 3. After 2 days, pound them again and change the paper. 4. Repeat the above process 6-7 times. 5. Press them until they have no more oil, and grind to be powder and screen.*()(parched Mylabris with rice): () () () ({}{}), (), () . () () (), ({}) (), ({}{}), ({}{}), () . () . ( 10kg : 2kg) 1. Parch the rice in a preheated pan over a medium fire. 2. As it smokes, add mylabris to it and parch until the rice become yellow and Mylabris looks red. 3. Take them out and sift out the rice and remove its wings and legs of drugs. (Cantharides 100kg : rice 20kg)* (Ranunculaceae) , Aconitum ciliare DC. (Ranunculaceae) .()(processed Wild aconite tuber ): () () () (), (), ({}), ({}{}) . (), () . 2-3 15 . () (), () 3-4 () () .( 100kg : 5kg : 10kg) 1. Soak the wild aconite tuber in cold water and change the water 2-3 times a day. 2. After 15 days if it tastes slightly pungent, take out and remove the root tip. 3. Boil it with licorice root and black soybean for 3-4 hours until it has no more white spots in the center of tuber and discard the licorice and black soybean. 4. Damp-dry it in the sun and slice, and dry again in the sun. (Aconoiti Ciliare Tuber 100kg : Glycyrrhizae Radix 5kg : Glycinis Nigrae Semen 10kg)* Aconitum carmichaeli Debx. (Ranunculaceae) . , 5.6-7.9mg/gm. aconitine , . mesoaconitine , . aconitine sodium ion . aconitine . , , , , , , , , , , , . 2-6gm, 2-4gm . .()(processed Aconite main tuber) :() (), (), () . (), (), (), () . () () 4-6 . () . () () , () . 1. Sort the aconite main tubers after their size and soak in water until they have no medulla inside. 2. Take them out and boil or simmer for 4-6 hours until they have no white spots and no more numbness in tongue. 3. Take them out and damp-dry in the sun. 4. Slice them and dry again in the sun. And you may boil the drug with black soybean, licorice decoction, ginger and beancurd, etc. There are more methods.* Cnidium officinale Makino (Umbelliferae) . , . PT time . phthalide (ligustilide, cnidilide, senkyunolide) . , , , , . (, , , ) 4-12gm .*1 case 0.6 3 URI 2270mg , 2case 5.7 1 Drugs for functional gastrointestinal disorders preterm

* Corydalis ternata Nakai (Papaveraceae) . dl-tetrahydropalmatine, d-corydaline , dl-tetrahydropalmatine , . , . Tetrahydropalmatine , ACTH . , , . .( , , , ) 4-12gm ()(processed Corydalis tuber with vinegar): () () . () 60% () . () .( 100kg : () 20kg) 1. Mingle the corydalis tuber with vinegar to permeate thoroughly. 2. Parch over a low fire in a pan to be dried up. 3. Take it out and cool. Or Boil the corydalis tuber and vinegar together in a pot until the tuber absorbs all the vinegar. Heat it to be dried and take out to cool.* 6 1 Drugs for functional gastrointestinal disorders, 35+4 NICU .

* Angelica gigas Naki . hemoglobin . Vitamin B12, folic acid . () () . , , , . , (, , , , Bacillus proteus, , ), . . (, , , , , , , , , , , , , , , )Mild; active, but toxicity appears very mild unless used for long time 1,2). Dong quai (Angelica sinensis), also called danggui, tang-kwei, or Chinese angelica, is a Chinese herb, the root of which has been used for various gynecologic conditions. Other species of angelica are cultivated for flavoring. In North America, dong quai may be used alone as an herbal treatment, but in traditional Chinese medicine it is mixed with other herbs. The compounds thought to be active in Angelica species include furocoumarins, including bergapten, imperatorin, psoralens, angelicone, angelol, osthol, and oxypeucedanin. A. sinensis also contains the lactones angelicide, butylidenephthalide, butylphthalide and ligustilide; safrole and isosafrole, ferulic acid, and beta-sitosterol.A study in seventy-one postmenopausal women found that when dong quai was used alone, it did not produce estrogen-like responses in endometrial thickness or in vaginal maturation and was no more helpful than placebo in relieving menopausal symptoms. Several cases of increased INR have been reported in patients on warfarin who ingested dong quai.Traditionally, dong quai is contraindicated during the first trimester of pregnancy. Aqueous extracts of A. sinensis root are reputed to be abortifacient; however, a secondary source states that studies in rats showed neither an anti-implantation nor an abortifacient effect. Dong quai extracts and components have variously been reported to increase or decrease uterine contractions in animals or in isolated uterine preparations. In vitro and in vivo studies of estrogenic bioactivity have also been mixed. An in vitro study found that an extract of dong quai stimulated the growth of MCF-7 human breast cancer cells but had no effect on uterine weight when an extract was administered by gavage to ovariectomized mice for four days. Additionally, the dong quai extract did not activate estrogen receptors.In Singapore, a case of gynecomastia was attributed to ingestion of "dong quai" pills ; however, the preparation was not analyzed for adulteration with drugs, a common problem in parts of Asia. We have been unable to locate other references on possible reproductive effects of this agent. [Dong quai has not been evaluated for pregnancy effects. It does not appear to have estrogenic effects or affect menopausal symptoms, but has stimulated the growth of breast cancer cells in culture.]

* 1 , 4 , 1 palpitation 2.5-7.4 * Mentha arvensis L. var. piperascens Malinv. . , (naphthaloum), , (, , alpha , Shigella flexneri, , , , , , Bacillus proteus, Candida albicans), (Herpes simplex, Papiloma virus) , , . . , , . . (, , , , , , , )* case 3.6 2 * Pinellia ternata (Thunb.) Breit (Araceae) . 7-8 . , , , , , . . , , , , , . , . (, , , , , ) ()(purified Pinellia tuber): () () () 3 () . (), () () ( 100kg : 20kg : 250kg).1. Scatter the alum powder on the selected pinellia tuber carefully and add some water to be soaked. 2. After 3 days no more numbness is left in the mouth, pour the alum water out and soak it in clean water for one day. 3. Boil it in a pot until it could be split. 4. Dry in the sun and make it bean-sized.(Pinelliae Tuber 100 kg : Alunite 20 kg : water 250 kg) , ()(processed Pinellia tuber): () () () ( : 2 ) 1-2 . () () (). () (), (), () . ( 100kg : 15kg : 10kg),1. Soak the pinellia in water until no more dried core could be seen. 2. Change the soaking water to licorice- limestone water(add the licorice decoction to limestone water) and stir it once or twice. 3. If it tastes slightly pungent and become yellowish, scoop up and wash and dry in the shade or heat in a drying room. (Pinelliae Tuber 100kg : Glycyrrhizae Radix 15kg : Calcaria 10kg) ()(processed Pinellia tuber with ginger): () () . . () . () (), () .( 100kg : 25kg : 12.5kg( 14.5kg)) 1. Soak the pinellia tuber in cold water in the shade for 10 days. 2. As white bubbles are formed, add pinellia tuber and alum for one day and change the water. 3. If it tastes slightly pungent, scoop up and dry in the sun. 4. Mix the pinellia and alum with the decoction of sliced gingers. Then boil them to permeate. 5. Take it out and dry in the shade and well-ventilated place until dried up. (Pinelliae Tuber 100kg : ginger 25kg : Alunite 12.5kg(14.5kg in summer))*URI 0.6 3 1 2,670mg* 57.8%, 23.1%, 28%, 14.2%, 24.9%, 21.8%, 31.7%, 21.8% 17.5% 17.5% 14.8%, 13.2% 13.8%, 13.2%, 13.8% 12.6%, 12.3%, 10.2% *

한약 in Pregnancy

Health & Medicine

Transcript of 한약 in Pregnancy